St. John's Wort
It is estimated that depressive illnesses afflict about 17.6 million adult Americans each year. In this country, depression is 1 of the top 10 most-likely reasons for someone to consult a family physician and costs our economy more than ulcers, diabetes, arthritis or hypertension.
Depression is characterized by a number of subjective symptoms, ranging from despondency and loss of interest to irritability and disturbances of eating and sleeping patterns. There are different degrees of depression (mild, moderate and severe) categorized by the frequency and severity of symptoms. Severe depression is often successfully treated with prescription drugs, all of which are synthetic. They may produce more-or-less unpleasant side effects, but can produce dramatic relief from depressive symptoms. Mild depression, in which symptoms don't interfere with normal daily activities, is more prevalent. In Germany, the most popular prescription drug of any type, natural or synthetic, for the treatment of mild depression is a concentrated extract of the flowers and leaves of St. John's Wort, often simply called hypericum. There, just under 200,000 prescriptions per month are filled for a single brand (Jarsin), compared with about 30,000 per month for fluoxetine (Prozac). This figure does not include sales of other hypericum products, whether they are prescribed or self-selected. Approximately 80% of the sales are prescriptions, which allows their cost to be reimbursed by the German health-insurance system.
Many clinical trials show St. John's Wort to be especially useful in treating mild depressive states. Studies in 3,250 patients found improvement or total freedom from symptoms in about 80% of the cases treated, with only 15% not responding.
Inside the Herb
The herb's multiple constituents apparently work in several different ways, one of which is MAO (monoamine oxidase) inhibition. A red pigment (hypericin) found in the herb has been shown to interfere with MAO, an enzyme in the brain that destroys various "feel good" amines, such as serotonin, epinephrine and dopamine. Certain foods rich in the amine tyramine must be avoided when any MAO inhibitor is being taken, otherwise serious side effects may occur. These foods include red wine, strong cheese, certain beans and the herb ephedra.
MAO inhibition, however, is just the start. Other components in St. John's Wort apparently inhibit COMT (catechol-O-methyltransferase), another enzyme capable of destroying "feel good" amines. Still another mechanism seems to suppress interleukin-6 release, affecting mood through neurohormonal pathways.
Translated, this biochemical jargon says that different chemical compounds in St. John's Wort work together to relieve mild depression in several different ways. The advantage of this combined action is fewer side effects for the consumer because the total response is not due to a single strong action.
Experts do warn against sun worship while consuming hypericum because it may induce photosensitivity, with its dermatitis and associated inflammation. But even though light-skinned animals grazing on great quantities of the herb have had such reactions, photosensitivity has not been reported in people taking it in normal amounts. It has occurred only in patients injected intravenously with very large amounts of hypericin — 50 to 70 times the normal oral dose.
St. John's Wort is marketed as a drug in Germany and has been approved there by the German equivalent (Commission E) of our FDA for the treatment of mild depression, anxiety and nervous unrest. But it is sold in the United States only as a dietary supplement. You may see it in the form of tea, powder, oil, liquid, tablets, capsules or dried leaves. The most effective preparations contain an extract of the herb standardized on the basis of its hypericin content. Use only products whose labels give the percentage of hypericin, and follow the dosage instructions. (Dosages vary depending on the hypericin concentration, but it is the equivalent of 2 to 4 grams of dried herb daily.) Improvement of mild depression should result after 2 to 6 weeks of treatment.
St. John's Wort has been shown to be beneficial only for the treatment of mild depression. Claims about other effective uses are just that — claims, without scientific backing. One such claim from folklore is that the herb is useful in healing wounds when the oil is applied externally.
Before you use St. John's Wort for mild depression, be sure that your condition has been accurately diagnosed by a qualified professional. (You should get a diagnosis before self-treating any serious disease.) It's vital to determine whether you suffer from severe depression (for which prescription antidepressants are probably your best bet) or some milder form of depression (for which St. John's Wort may be appropriate). Inform your physician of your intentions — specifically, your desire to use an herbal product for the condition. Unfortunately, we know very little about the interactions of St. John's Wort with other drugs. In spite of its widespread use in Europe, however, no contraindications or serious side effects have ever been noted.
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